Responses to Therapeutic Interventions in Physiotherapy
INTRODUCTION
Physiotherapists play a vital role within the health care system establishment. They provide patient education, disease prevention and rehabilitation according to the needs of the patient. For optimal functionality in providing the best of services, physiotherapists are to be skillful in all approaches particularly in their interventions. This includes several therapeutic interventions. Physiotherapy Therapeutic interventions are evidence-based interventions that help individuals improve movement, reduce pain, restore function and prevent future disability and loss of mobility before it occurs. ( https://profectum.org/physical-therapy-interventions/).
The Core values of physical therapy interventions include; • Promoting the patient’s ability to move • Reducing the client/patient pain • Restore, improve, and maintaining optimal physical function, wellness and fitness, as well as quality of life as it relates to health and movement. • Prevent the onset, symptoms and progression of functional limitations, impairments, and disabilities that result from injuries, disorders, conditions and diseases. • Educating client/patients on how to prevent or manage their condition in order to promote functional independence. (Bezner J.R., 2015)
Types of physiotherapy therapeutic interventions There are several types of interventions applied in physiotherapy. • Direct intervention (e.g., therapeutic exercise, manual therapy techniques, debridement, wound care) • Patient-related instruction (e.g., education provided to the patient and other caregivers involved regarding the patient’s condition, treatment plan, information and training in maintenance and prevention activities) • Coordination, communication, and documentation (e.g., patient care conferences, record reviews, discharge planning) (Hall & Brody, 2005)
PATIENTS RESPONSE
Patients’ responses are key to the reassessment of the patient’s condition and the relative improvement consequential to the therapeutic intervention. There are several types of positive and negative responses to treatment. Predominant responses include the following; • DENIAL OF LIMITATIONS Patient’s perceptions of disability may relate to whether they are in pain or have their normal routine disrupted by the therapeutic intervention. Denial slows down the progression of treatment as he/ she may avoid treatment. • ANGER Patients often become angry when they recognize their loss. The anger might be directed toward God, their parents, the physician, or even themselves. Some exhibit self-destructive behavior, such as use of cutting, alcohol or other substances, as a way to demonstrate anger. • DEPRESSION Depression or sadness reflects a loss of health and pain. Depression symptoms manifest in a variety of ways: loss of interest, poor appetite, crying episodes, withdrawal, and sleep disturbance. Sadness is a pathognomonic sign of depression in adults. They frequently abandon former goals, become withdrawn, "act out," or stop taking their medications. Consideration or attempts of suicide occur in with significant depression, regardless of their age. • ANXIETY Anxiety arises from uncertainty. Often, the less that is known about the patient's prognosis, necessary treatment, or projected length of illness, the greater the level of anxiety. Procedures and hospitalization are often anxiety-producing. Anxiety about social acceptance and the impact of the condition on social functioning are noted during therapeutic intervention. • ACCEPTANCE Patients often learn proactively get better by following the recommended treatment procedure with optimism. Some lead full lives despite or even with chronic conditions. Depending on the severity, as adults, they may be able to live in an independent living center with caretakers available for certain times and functions of the day. https://www.utmb.edu/Pedi_Ed/CoreV2/ChronicConditions/ChronicConditions4.html
The patient’s reaction to therapeutic intervention is dependent on many factors including: • Age of the patient • Therapeutic intervention applied as part of treatment • The level of disability of the patient • The level of support received by family, friends, caregivers and medical team • The ability to communicate effectively with the medica team • Time of intervention. • Psychological state of mind
HOW TO MEASURE A PATIENT’S RESPONSE TO A THERPEUTIC INTERVENTION
Outcome measures are very important viable tools that help to understand and measure the responses of the patient towards the therapeutic intervention. They help to establish the baseline, improvement and development in relation to the treatment received. With Evidence Based Practice (EBP) in health care, outcome measures provide credible and reliable justification for treatment on an individual patient level. The results from outcome measures can also be grouped for aggregated analysis focused on determining quality of care. When outcome measures are used in an aggregated data situation to compare results, a risk adjustment process is required to fairly compare results (Gvozdyev BV et al 2017)(Deutscher D, et al 2018). Outcome measures are divided into four categories: • Self-report measures • Performance-based measures • Observer-reported measures • Clinician-reported measures Self-report measures are typically captured in the form of a questionnaire. The questionnaires are scored by applying a predetermined point system to the patient's responses. Although self-report measures seem subjective in nature, self-report measures objectify a patient's perception. Computer based or electronic self-report measures are available. Electronic measures may be fixed-form or adaptive. Computerized adaptive testing is a method of testing that determines the questions for a response based on the patient's previous responses. (McCabe E, et al.,2018) The questionnaires where the patient reports on health or physical function are known as patient-reported outcomes (PRO) [ Kyte DG, et al. 2015]. PROs have been defined as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else."(Black N,2013) Performance-based measures require the patient to perform a set of movements or tasks. Scores for performance-based measures can be based on either an objective measurement (e.g., time to complete a task) or a qualitative assessment that is assigned a score (e.g., normal or abnormal mechanics for a given task). Performance-based measures and patient reported measures both capture a current status. These measures do not typically equate with each other. Performance-based measures tend to bring to light physiologic factors. Patient reported outcome measures may capture a patient's perception, beliefs, social factors and/or health factors. (Bean JF et al.2011) Observer-reported measures are measurements completed by a parent, caregiver or someone who regularly observes the patient on a daily basis. Clinician-reported measures are measurements that are completed by a health care professional. The professional uses clinical judgement and reports on patient behaviors or signs that are observed by the professional.
Key notes
Conclusion
REFRENCES
1. https://profectum.org/physical-therapy-interventions/).
2. Janet R. Bezner, Promoting Health and Wellness: Implications for Physical Therapist Practice, Physical Therapy, Volume 95, Issue 10, 1 October 2015, Pages 1433–1444, https://doi.org/10.2522/ptj.20140271
3. Hall & Brody: Therapeutic Exercise: Moving Toward Function, 2nd Edition© 2005, Lippincott Williams and Wilkins)
4. Gvozdyev BV, Carreon LY, Graves CM, Riley SA, McGraw KE, Head RJ, Dimar JR, Glassman SD. Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions. Journal of Neurosurgery: Spine. 2017 Oct 1;27(4):397-402.
5. Deutscher D, Werneke MW, Hayes D, Mioduski JE, Cook KF, Fritz JM, Woodhouse LJ, Stratford PW. Impact of risk adjustment on provider ranking for patients with low back pain receiving physical therapy. Journal of Orthopaedic & Sports Physical Therapy. 2018 Aug;48(8):637-48.
6. McCabe E, Gross DP, Bulut O. Procedures to develop a computerized adaptive test to assess patient-reported physical functioning. Quality of Life Research. 2018 Sep 1;27(9):2393-402.
7. Kyte DG, Calvert M, Van der Wees PJ, Ten Hove R, Tolan S, Hill JC. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015 Jun 1;101(2):119-25.
8. Black N. Patient reported outcome measures could help transform healthcare. BMJ: British Medical Journal. 2013;346.
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